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rUK UN-R-t USt: - - --------- --------- - ----------- --- ---- -------- ------- -- -- APPLICATION FOR SANITATION PERMIT Permit No. -- --- ------ 7 ------ --------- (Complete in Duplicate) -- ----- -- - -------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND LOCATION__ C` ----- -- ------- -- ------ ------------------ --- Owner's Name------- V__ i ---- -- ---------- ------ - - - Phone -------- - ---- --Address--------------- � - --- -------- 4;111 0 Contractor's Name - c._ .. -- ------�� ---------- -- �-- ----- - - -- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel -1Other E] Number of living units: J.___ Number of bedrooms,.2--�__ Number of baths Lot size ... -___----�.-f„5- ---- -------------- Water Supply: Public system E] Community system E] Private Depth f Water Table 170-_If- Character of soil to a depth of 3 feet: Sand E] Gravel ❑ San2ly Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date ---- .--._ I No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ( septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank• Distance from nearest we1L_5?7_1--Distance.from att - - --- -_t- on-_--/ --__f Mrial___No. of compartments--. - ---- 9_ Liquid depth - e _..�Capac�ity._ - _-Z-_(.'--4r Dispos Field: Distance from nearest wellDistance from foundation--- ----Distanc - to nearest lot line-5, Number of lines-------- --_ - - -------_ - -, Length of each line---.-�-�-----------------Width of trench..----�-- ---- T e of filter materia__-_. p 7 -';L— Type 1 _ e De th of filter material______f. �r Total length-_� Seepage Pit: Distance to nearest well. -- ---------------Distance from foundation---------__-------- ...._____ -- Cesspool: Distance from nearest well----------.------Distance from foundation -_-__-.._ Lining material__...-_________________________ ❑ Size: Diameter.__ ... -..___ Depth -------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well-----------------------------_----- -_- -Distance from nearest building,El Q Distance to nearest lot line.. Remodeling and/or repairing (describe)---------- -------- .- ----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a , and rules and r gulations of the n Joaquin Loc Health District. C Si ned � � •- { g )--- -- `'�-- ---------- - -- ner and/or Contractor) Sy:------- - --- it.: c - ---GLC - _(Title)--- - - - - ----- - (Plot plan, showing size of lot, location of system in relation to wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �v APPLICATION ACCEPTED BY.- :' --------- ----------------------- ----------- DATE. - `- REVIEWED BY ---------------------------- ----- -- -- -------- -------------- - ' ----- -- - DATE - UILDING PERMIT ISSUED----------- ----- ---- --------- �- - ------------ ----------- ----------- terations and/or recommendations:...___-- ------------- -- DATE----- ------ ----------- --- --------- - -------- �7 I / FINAL INSPECTION BY:_. i.:-..: Date..- _Jr_'`z -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haztllon Avo. 300 West Oak Street 12 4 Sycamore Street Stockton,California 205 West 91h Street ES 9 REVISED 8-59 3M 3-'63 F.P.E D. lodi, California Manteca, California iracyr California